Why Your Doctor Appointment is Late

Insights from Dr. Ramsey Markus

A common complaint I hear from people is their annoyance with late-running doctor appointments. I’m very sensitive to this issue. When I went to medical school, my goal was to be efficient and see my patients right on time. I didn’t understand what “on time” meant until I became a practicing physician.

A smoothly running schedule depends on a lot of factors. I’ll share these along with some recommendations I’ve learned that, if followed, will contribute to a positive patient experience.

Even before the appointment, there are factors completely out of our control. We have patients who drive great distances to come to our office. People get stuck in traffic, have difficulty parking, or get lost. If someone has made the effort to come to see me, I’ll do my best to see them.

Let’s consider an example of an 11 AM appointment. Sometimes people interpret this to mean they see their doctor at that exact time. In our office (which is typical of most doctor offices), this time marks the arrival. There’s a lot of necessary behind-the-scenes work that must be done before we can even invite a patient into the exam room.

Before entering the exam room, patients must complete or update forms. Registration, medical history, insurance, referrals, and privacy are some of the forms we need to maintain our legal obligations and understand a patient’s full medical profile. We have to make charts for new patients. In our office we provide forms online for patients to download and complete before they come to the office but not everyone does this. By the time paperwork is complete, it’s now 11:20 AM.

It’s nearly impossible to tell if an appointment is going to last 5 or 45 minutes. Some patients require more time than others, even for the same exact concern. For example, if two people come for a quick skin check, one may need several biopsies and precancers treated. Complications are often unforeseen and require additional time. Moreover, some patients are very anxious and require more reassurance and explanation. It’s my hope that other patients are understanding regarding delays caused in this situation, because if it were them, we would provide the same level of attention.

Sometimes patients arrive with long lists and want to discuss more than what was initially scheduled. When it concerns non-critical issues, I’m faced with an unpleasant choice: do I limit my patient’s discussion to the top issues or do I systematically address all their concerns in a single visit? I try to address the entire list whenever possible, but in my opinion it’s in the patient’s best interest to focus on the information, education, and treatment for the top one or two issues to ensure understanding and retention. I find some patients want to have an exhaustive review of many issues, but from a scheduling perspective it puts everyone behind. And remember, after each patient, every issue needs to be carefully documented. Ironically, the patients who complain most about waiting are typically the patients who take the longest time.

People ask me if scheduling more time for each patient is a viable solution. I’ve done as much as possible, but there are limits. Modern medicine facilities like our office demand a certain amount of overhead to remain open and functional. Rent, lighting, nursing staff, equipment, malpractice insurance, billing costs and declining reimbursement payments require dermatologists to see between 4 and 8 patients per hour to pay the bills.

I’ve tried extremely hard to maintain a timely schedule and have improved over the years, but it is still a daily challenge. There have even been studies on this very issue and they all come to this same conclusion. For my part, I arrive to work on time, focus on patient care, and schedule realistically.

Knowing that medical schedules are unpredictable and variable, I have some recommendations for you.

If promptness is absolutely necessary, schedule your appointment early in the morning. These appointments are most likely run on time.

Search for a physician with realistic scheduling. I only schedule what I know I can handle. Some physicians will intentionally overbook assuming someone won’t show up. Unfortunately, this may be impossible to determine.

Do everything you can ahead of time to ease the process. Fill out all forms if they are available online. Try and arrive early to handle any last minute administrative obligations.

Be efficient with your questions after the exam by focusing on your biggest concerns. You will gain a higher level of quality time on the information your doctor shares with you.

Take care of common sense items. Wash off any makeup if your facial skin is being examined, and put on your gown before your doctor knocks on the door.

Bring something to do. Many people use the time to relax or to accomplish a task. So bring your computer (we have WiFi), homework, or a book to read while you’re in the waiting room.

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